Neuromodulation Applications in Alcohol Use Disorder

评估实时功能磁共振神经反馈-在过去的四年中，我们与国家精神卫生研究所(NIMH)的合作者合作，为西门子3T棱镜扫描仪开发和实施了几个神经反馈原型。我们已经完成了这项研究的第一阶段，并继续从酒精使用障碍(AUD)住院患者行为单元招募第二阶段的研究人员。《心理生理学》杂志(Fede等人，2023年)发表了一篇手稿，详细介绍了三种实时神经反馈算法的评估，目的是降低渴望。在这项研究中，参与者接受了三种神经反馈中的一种：多感兴趣区域(ROI)、连续反馈支持向量机(CSVM)和间歇反馈支持向量机(ISVM)。根据成功率、神经下调调节的变化和自我报告的饮酒欲望的变化来评估表现。根据我们的结果，参与者在第4轮比第1轮有更多的成功试验，以及改善了脑岛、前扣带回和背外侧前额叶皮质(DlPFC)的下调。后两个地区更大程度的下调预示着欲望的更大程度的降低。与其他两种方法相比，独立支持向量机的性能要差得多。纹状体和dlPFC的下调是由ROI实现的，而不是CSVM神经反馈，与渴望的更大程度的减少相关。我们的结果表明，多ROI方法比支持向量机和间歇反馈方法更具优势。 负性紧迫症的TMS神经调节 我们原计划与Lauren Atlas博士启动另一项合作研究，以评估酒精使用障碍(AUD)患者的负性紧迫感与冲动决策的关系；并使用功能性近红外光谱(FNIRS)成像来表征相关额叶区域的血流动力学反应。由于新冠肺炎的限制，这个项目的实验室空间准备工作被推迟。在初步研究完成后，我们将测试是否可以通过使用重复经颅磁刺激(RTMS)的前额叶刺激来调节负面紧迫感，因为这项技术已经被证明影响情绪调节和冲动决策过程中自上而下的调节电路(前额缘)，这是负面紧迫感的两个关键组成部分。

Evaluating Real Time fMRI Neurofeedback - During the past four years we have worked with collaborators in the National Institute on Mental Health (NIMH) and developed and implemented several neurofeedback prototypes for the Siemens 3T Prisma scanner. We have completed stage 1 of this study and continue our recruitment for stage 2 of the study from the Alcohol Use Disorder (AUD) inpatient behavioral unit. A manuscript was published in the journal of Psychophysiology (Fede et al., 2023) detailing the evaluation of three real time neurofeedback algorithms with the goal of downregulating craving. In this study participants received one of three types of neurofeedback: multi-region of interest (ROI), support vector machine with continuous feedback (cSVM) and support vector machine with intermittent feedback (iSVM). Performance was assessed on the success rate, change in neural downregulation and change in self-reported craving for alcohol. According to our results, participants had more successful trials in run 4 versus 1, as well as improved downregulation of the insula, anterior cingulate, and dorsolateral prefrontal cortex (dlPFC). Greater downregulation of the latter two regions predicted greater reduction in craving. iSVM performed significantly worse than the other two methods. Downregulation of the striatum and dlPFC, enabled by ROI but not cSVM neurofeedback, was correlated with a greater reduction in craving. Our results suggested an advantage of multi-ROI over SVM and intermittent feedback approaches. TMS Neuromodulation of Negative Urgency We had planned to initiate another collaborative study with Dr. Lauren Atlas in order to assess how negative urgency relates to impulsive decision-making in individuals with alcohol use disorder (AUD); and to characterize the associated hemodynamic response in prefrontal areas using functional near infrared spectroscopy (fNIRS) imaging. Due to COVID-19 restrictions the preparation of laboratory space for this project has been delayed. Upon completion of the pilot study, we will test whether negative urgency can be modulated via prefrontal stimulation using repetitive transcranial magnetic stimulation (rTMS), as this technique has been shown to affect top-down regulatory circuits (prefrontal-limbic) during emotion regulation and impulsive decision-making, which are the two key components of negative urgency.